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Re: NHS

#41  Postby Tracer Tong » Oct 02, 2017 9:34 pm

Sendraks wrote:
Tracer Tong wrote:
I'd say most of this is fair, though, as I've already indicated, this seems to me to amount to not much more than a stay of execution.


I'm not seeing any information to suggest that the NHS is ultimately not sustainable. The NHS needs to change, although Government funding priorities to focus on adult social care is the more pressing concerning for NHS sustainability.

It'd be nice if you could cite a report or some other evidence in support of the view about the ultimate un-sustainability of the NHS.


Tracer Tong wrote:Well, I'd be delighted to explain my view on the matter; but see our previous discussion.


I'm rather more interested in to why what I've cited on NHS choices could be construed as vague, given that is a relatively fixed point of reference, rather than more subjective notions.


Well, if you were that interested, and it were that nice... ;)
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Re: NHS

#42  Postby Sendraks » Oct 02, 2017 10:25 pm

Healthcare costs unsustainable in OECD countries without reform.
http://www.oecd.org/health/healthcarecostsunsustainableinadvancedeconomieswithoutreform.htm
Nothing in there about the NHS being ultimately unsustainable.

Indeed, a quick google search on unsustainable healthcare brings up hits about the US system, rather than European systems or the NHS. And the US system is widely acknowledged to be one of the most costly and inefficient systems going.

By comparison, the rightly hightly regarded Dutch healthcare system is facing the same challenges of sustainability as other European healthcare systems and needs to adapt and reform to be sustainable in the longer term.

https://www.mckinsey.com/netherlands/our-insights/a-vision-for-dutch-health-care-in-2040

There are some unique factors facing the Dutch system, they already spend a lot and the expectation is that Dutch people are entitled to the highest standard of care is driving up costs. Because of how the Dutch healthcare system is set up and as Scot has already pointed out, the Dutch increasing elderly population is not impacting on their costs in the same way as other nations such as the UK.
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Re: NHS

#43  Postby Tracer Tong » Oct 02, 2017 10:34 pm

Sendraks wrote:Healthcare costs unsustainable in OECD countries without reform.
http://www.oecd.org/health/healthcarecostsunsustainableinadvancedeconomieswithoutreform.htm
Nothing in there about the NHS being ultimately unsustainable.


Well, that report claims that "Healthcare costs are rising so fast in advanced economies that they will become unaffordable by mid-century without reforms". I don't disagree in regards to the NHS.

Sendraks wrote:
Indeed, a quick google search on unsustainable healthcare brings up hits about the US system, rather than European systems or the NHS. And the US system is widely acknowledged to be one of the most costly and inefficient systems going.


No argument from me there, either: the American healthcare system is probably even less sustainable than the NHS.
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Re: NHS

#44  Postby Sendraks » Oct 02, 2017 10:38 pm

Tracer Tong wrote:Well, that report claims that "Healthcare costs are rising so fast in advanced economies that they will become unaffordable by mid-century without reforms". I don't disagree in regards to the NHS.


And that is entirely consistent with what I've been saying.

Tracer Tong wrote:No argument from me there, either: the American healthcare system is probably even less sustainable than the NHS.

Full stop or simply without reforms?
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Re: NHS

#45  Postby Tracer Tong » Oct 02, 2017 10:49 pm

Sendraks wrote:
Tracer Tong wrote:Well, that report claims that "Healthcare costs are rising so fast in advanced economies that they will become unaffordable by mid-century without reforms". I don't disagree in regards to the NHS.


And that is entirely consistent with what I've been saying.


Of course. The difference probably lies in the fact that I think such such reforms as will be required will result in the end of the NHS, even if we continue to refer to what comes out the other side by the same name.

Sendraks wrote:
Tracer Tong wrote:No argument from me there, either: the American healthcare system is probably even less sustainable than the NHS.

Full stop or simply without reforms?


I'm referring to the situation as things stand.
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Re: NHS

#46  Postby Sendraks » Oct 03, 2017 8:40 am

Tracer Tong wrote:Of course. The difference probably lies in the fact that I think such such reforms as will be required will result in the end of the NHS, even if we continue to refer to what comes out the other side by the same name.


Why do you think that? What's your evidence base on which your thoughts are based?

The NHS has changed a lot over the course of its history, with most of the change being in the last twenty years to accommodate the system we have today. Yet the publicly funded model of care remains in place, as do the core principles of the NHS. Indeed, if anything the core principles of the NHS have been increasingly strengthened over the last ten years following the introduction of the NHS constitution.

For the NHS to "end" it is these things which have to go and thus far, I'm not seeing any evidence to suggest that publicly funded care which is free at the point of need, is unsustainable.
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Re: NHS

#47  Postby Scot Dutchy » Oct 03, 2017 9:56 am

Thanks Sendraks for the McKinsey report :thumbup: Very interesting.

Already since that report many points have already been acted upon. The more obvious one is specialisms done in hospitals. We have four hospitals in our group area and certain departments have closed and moved to others so we dont have hospitals all offering the same care and treatment. A sort of jack of all trades and masters of none thing. All A&E's offer the same care but the hospital you may end up in could be a different one. This increases efficiency and care. This has already happened in most parts of the country. The hospitals in the group btw have all good public transport access and are only 20 mins apart by bus or tram. A free shuttle bus is offered between hospitals as well. This is very recent. The presence of more clinics also fits into the McKinsey vision.

I still think for our basic €1200 per year we get a good service. The rates are fixed annually and the part of the private competition that takes place. The ceiling is fixed by the health committee made up of insurers, health inspectorate, health care reps and patient reps. The ceiling was fixed for next year at €1280 for the basic package. The first company as announced its next year rate with a reduction of €72 on the present rate not even the new one. It will be interesting to see what the others do.
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Re: NHS

#48  Postby Sendraks » Oct 03, 2017 10:15 am

Scot Dutchy wrote:. The more obvious one is specialisms done in hospitals. We have four hospitals in our group area and certain departments have closed and moved to others so we dont have hospitals all offering the same care and treatment.


This has been something that successive Government's have tried to move towards in England over the last twenty years but, has met with considerable opposition from the public. We don't need hundreds of identikit acute hospitals across the country, because that creates a lot of duplication and waste. The problem is the public suffer from HIMBYism (Hospital In My Back Yard) and don't understand why they shouldn't have all the acute services in their locality, so refuse to accept that such services should move. But, we don't need a cardiac speciality in every hospital. We don't need a maternity service in every hospital.

But, you suggest that someone might have to drive 5 to 20miles further to access these services and you'd think someone had pissed in their cornflakes and suggested they eat it!

The barrier to success here isn't the health service but, the politicisation of the health service and the numerous problems with our current political system which allow local MPs to use the local NHS as a bargaining chip. The 2012 Act (for all its faults), was a step in the right direction at moving the NHS further from the political sphere but, its probably not far enough to allow decisions about re-configuring services to be made free of interference.
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Re: NHS

#49  Postby Tracer Tong » Oct 03, 2017 10:22 am

Sendraks wrote:
Tracer Tong wrote:Of course. The difference probably lies in the fact that I think such such reforms as will be required will result in the end of the NHS, even if we continue to refer to what comes out the other side by the same name.


Why do you think that? What's your evidence base on which your thoughts are based?

The NHS has changed a lot over the course of its history, with most of the change being in the last twenty years to accommodate the system we have today. Yet the publicly funded model of care remains in place, as do the core principles of the NHS. Indeed, if anything the core principles of the NHS have been increasingly strengthened over the last ten years following the introduction of the NHS constitution.

For the NHS to "end" it is these things which have to go and thus far, I'm not seeing any evidence to suggest that publicly funded care which is free at the point of need, is unsustainable.


See our previous discussion.
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Re: NHS

#50  Postby Sendraks » Oct 03, 2017 10:33 am

I'm afraid you didn't provide any evidence earlier in support of your position.

As it stands, the position currently supported by evidence is that the NHS as a publicly funded, free at the point of need service, is sustainable providing there are ongoing reforms to Government spend and the reconfiguration of services (as opposed to wholesale changes to the system architecture which ultimately proved to be little more than disruptive).
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Re: NHS

#51  Postby Tracer Tong » Oct 03, 2017 11:31 am

Sendraks wrote:I'm afraid you didn't provide any evidence earlier in support of your position.


I’m afraid you didn’t meet the modest conditions for further discussion on the matter. If you still have no intention of doing so, why continue to ask?

Sendraks wrote:
As it stands, the position currently supported by evidence is that the NHS as a publicly funded, free at the point of need service, is sustainable providing there are ongoing reforms to Government spend and the reconfiguration of services (as opposed to wholesale changes to the system architecture which ultimately proved to be little more than disruptive).


I beg to differ.
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Re: NHS

#52  Postby Sendraks » Oct 03, 2017 11:38 am

Tracer Tong wrote:why continue to ask?
I'm factually stating that you've provided no evidence to support your position. It is not a request.

Tracer Tong wrote:
I beg to differ.


The evidence base thus far does not support your differing. Unless you can back your position up, as I have, your differing hardly matters.
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Re: NHS

#53  Postby Tracer Tong » Oct 03, 2017 11:46 am

Sendraks wrote:
Tracer Tong wrote:why continue to ask?
I'm factually stating that you've provided no evidence to support your position. It is not a request.


But your recent “Why do you think that? What's your evidence base on which your thoughts are based?” was. I’m factually stating that you won’t be getting answers to these questions until you meet the modest requirements specified, and wondering why you continue to pose these questions despite knowing this.

Sendraks wrote:
Tracer Tong wrote:
I beg to differ.


The evidence base thus far does not support your differing. Unless you can back your position up, as I have, your differing hardly matters.


And I’ll be delighted to do so, once you make the requisite commitments. I’ll note that at least one of the reports you cited does indeed support my differing.
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Re: NHS

#54  Postby Sendraks » Oct 03, 2017 11:54 am

That's fine. We can discard your differing vis the NHS and move on. That which is claimed without evidence can be discarded without evidence.
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Re: NHS

#55  Postby Tracer Tong » Oct 03, 2017 12:02 pm

You can discard whatever views (and cite whatever dodgy Hitchonian aphorisms) you like. I’ve merely laid out the very basic requirements for further discourse; if you don’t want to meet them, and so hear the reasoning behind my view you’ve asked about, that’s up to you.
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Re: NHS

#56  Postby Scot Dutchy » Oct 03, 2017 12:42 pm

Sendraks wrote:The barrier to success here isn't the health service but, the politicisation of the health service and the numerous problems with our current political system which allow local MPs to use the local NHS as a bargaining chip. The 2012 Act (for all its faults), was a step in the right direction at moving the NHS further from the political sphere but, its probably not far enough to allow decisions about re-configuring services to be made free of interference.


It is an unwritten rule but I dont when it appeared probably in the 50's when social democracy was being evolved here. Of course up to 2006 our system was a copy of the NHS but during the change health care was considered above politics. The fact that all private care was not allowed made it party-less. The same is true of education and social care.
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Re: NHS

#57  Postby Sendraks » Oct 03, 2017 12:52 pm

I'm not sure the removal of private healthcare would tackle the issue of HIMBYism. As long as people are going to be swayed by an MP who will "fight to keep your local hospital services" over an MP who supports a reconfiguration because they understand it as being better for the system overall, the problem will persist.

An inevitable reality of re-configuring services it means that services will be closer to some people than others. The English appear to be very bad at accepting this and don't like the idea that a service which was a mile from their house is now 5miles away and people 5miles away now have that service closer to them. Of course all of this is complicated by infrastructure and public transport (or lack thereof) exacerbating the issue.

Basically we need to change a lot of things, because all systems (healthcare, social care, education, transport etc etc) are interconnected and there are limits to how much you can change any one thing in isolation.

If you set up a specialist unit, people need to be able to access that unit. If there is limited public transport to its location, how do people get there? If everyone is driving, will that create congestion? Will people complain about car parking charges (answer is always yes).
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Re: NHS

#58  Postby Scot Dutchy » Oct 03, 2017 1:44 pm

Well it removed it from the political arena. The whole question of private care threatened to move it to centre stage but when everybody was equal and were seen to equal then it moved off stage.
The emphasis on private transport has always bedevilled British infrastructure. Even in the highly densely populated areas public transport has never been innovative.
London still has its big red buses (too many of them competing with other traffic for road space) and overfull underground. Its botched attempts are cycle infrastructure has created more injuries and chaos. It has not improved the quality of life but created more aggression on the streets. Our cycle infrastructure is one of major attributes to the relaxed way of life here and the happiness of the children. The way infrastructure is run has a massive influence on society.
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Re: NHS

#59  Postby Sendraks » Oct 03, 2017 1:49 pm

Scot Dutchy wrote:Well it removed it from the political arena.


In the Netherlands, yes. But, there will be a lot of other social and political factors which influenced that end result.

My point is that the political factors in the UK are not about private healthcare but, about local access to services and the misconceptions by the English public about what those services should be. You won't remove those problems and the politicisation of those problems by ending private healthcare.
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Re: NHS

#60  Postby Scot Dutchy » Oct 03, 2017 5:16 pm

Of course the word compromise is not common in British society and politics. NYBYism is typical British.
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